摘要
目的 :探讨改良胸大肌肌皮瓣在复发性头颈癌挽救性手术缺损重建中的应用价值。方法 :选择19例局部复发头颈癌患者,复发癌临床分期为2例r CSⅢ期,17例r CSⅣ期;挽救性手术前,17例接受肿瘤根治手术,16例接受放射治疗。应用胸大肌肌皮瓣重建挽救性手术缺损,制备时血管蒂内同时保留胸肩峰血管的胸肌支及胸外侧血管的分支,形成起始部不含肌肉的双蒂血管筋膜束。结果:胸大肌肌皮瓣全部成活,2例肌皮瓣与受区缝合处局部开裂,经换药1例5周后延期愈合,1例不愈出现咽瘘;13例患者的血管蒂置于锁骨下,另6例血管蒂位于锁骨表面;蒂长平均15.7 cm,最长达20 cm,修复高度达颧弓平面。随访6~48个月,10例患者无复发生存,5例患者带瘤生存,4例患者死于肿瘤复发和转移。结论:改良后的胸大肌皮瓣,双血管供血血运得到充分保证,避免了皮瓣局部坏死,其修复半径明显延长,解决了保留胸外侧血管修复半径缩短的难题,在复发头颈癌挽救性手术缺损重建中应用效果满意。
[Abstract] PURPOSE： To explore the value of modified pectoralis major myocutaneous flap in recurrent head and neck cancer salvage surgery. METHODS： Nineteen patients with locally recurrent head and neck cancer were selected and the clinical staging was rCS stage Ⅲ in 2 cases, rCS stage IV in 17 cases. Before salvage surgery, 17 patients underwent radical tumor resection and neck dissection, 16 cases received radiotherapy. Pectoralis major myocutaneous flap was applied to reconstruct the defects after salvage surgery. During preparation, the pectoral branches of thoracoacromial vessels and branches of lateral thoracic vessels were preserved as vascular pedicle to form bipedicled fascia vascular bundle without muscle at the origin. RESULTS： All pectoralis major muscle flaps survived. Two cases developed dehiscence： after dressing for 5 weeks, 1 case had delayed healing, 1 case had pharyngeal fistula. The vascular pedicle passed through subclavian space in 13 cases, passed over the clavicle in 6 cases. The muscle pedicle length was 15.7 cm at average; the maximum length was up to 20 cm, reaching high to the maria arch. The patients were followed up for 6 to 48 months, 10 cases survived without recurrence, 5 patients survived with tumor, 4 patients died of tumor recurrence and metastasis. CONCLUSIONS： The modified pectoralis major myocutaneous flap has double artery blood supply. It avoids the occurrence of local flap necrosis and its repair radius is significantly prolonged, eliminating the accessible limit of preserving lateral thoracic vessels. It has satisfactory results in recurrent head and neck cancer salvage surgery.
出处
《中国口腔颌面外科杂志》
CAS
2017年第4期357-360,共4页
China Journal of Oral and Maxillofacial Surgery
关键词
头颈肿瘤
复发癌
胸大肌肌皮瓣
挽救手术
Head and neck neoplasms
Recurrence carcinoma
Pectoralis major myocutaneous flap
Salvage surgery
